Blogging @ My EHR Experiences

Reimbursement Concerns Over EHR Workarounds

Several weeks ago, I wrote a post about physicians using workarounds in their EHR system.
The American Medical Association (AMA) released a statement about this very issue last week, and the implications are serious. Media Health Leaders wrote an in-depth post about the statement, and its potential effects.

According to the AMA, some Medicare carriers have issued rules stating that if patient charts look too similar, they will deny payment for them. This is the case even when physicians are using the EHR software appropriately.

In essence, this means that some physicians will have to reengineer their clinical notes in order to receive payment.

All of you who work in a clinical setting understand how serious this is. And, we all know that inputting a clinical experience into some EHR systems can be an incredibly frustrating, time-consuming chore. Because of this, some physicians use workarounds like templates and cut-and-paste for static information. Of course they do: these shortcuts save time and energy. And it’s understandable, especially when physicians are forced to work within a system that doesn’t meet their needs.

The problem is that these shortcuts can potentially harm patients when they’re used with non-static information like notes. Physicians who cut-and-paste notes without attribution or attention to what’s written there can seriously undermine patient care, and even put them at risk.

So, this is a valid concern and risk. However, threatening physicians with non-payment if charts look too similar is not an intelligent way to address this risk. Many charts DO look the same, with the same wording, tone, or style, simply because one physician may describe a condition so precisely and eloquently that other physicians adopt the description for their own use. Even with attribution, this causes charts to look “the same.”

But according to the rules set forth by some Medicare carriers, this practice (even though it’s harmless) can result in non-payment moving forward.

Many CIOs are pushing for a 12-month extension of Meaningful Use Stage 2; this would give everyone more time to address this issue, along with other pressing concerns, and hopefully iron out the details before physicians are penalized for practices that are necessary for effective patient care.